ESVD联合EIS治疗食管-胃连通型静脉曲张的安全性及可行性分析

Safety and feasibility analysis of ESVD combined with EIS in treatment of esophageal and gastric varices

摘要:

目的 探讨内镜下贲门胃底静脉曲张精准断流术（ESVD）联合内镜下食管静脉曲张硬化剂注射治疗术（EIS）在食管-胃连通型静脉曲张治疗中的临床疗效及安全性。方法 选择该院肝硬化合并食管-胃连通型静脉曲张破裂出血的患者260例，根据不同治疗方法分为3组：食管静脉曲张套扎治疗组（EVL组）、EIS治疗组（EIS组）及ESVD联合EIS组（联合治疗组）。术后随访2年，比较3组的静脉曲张改善率（3个月后）、早期再出血率（2周内）、迟发性再出血率（3个月内）、总再出血率（2年内）、并发症发生情况和治疗费用。结果 3组患者静脉曲张总改善率为93.5%（243/260），联合治疗组高于其他两组（P < 0.05）；3组患者早期再出血率比较，差异无统计学意义（P > 0.05），联合治疗组迟发性再出血率和总再出血率均较其他两组低（P < 0.05）；3组均未发生异位栓塞，联合治疗组术后发热发生率明显高于其他两组（P < 0.05），EVL组术后疼痛感强于其他两组（P < 0.05）；联合治疗组治疗费用明显高于其他两组（P < 0.05）。结论 对于食管-胃连通型静脉曲张，ESVD联合EIS治疗可取得较好疗效，且未明显增加并发症发生率，但治疗费用可能偏高。

Abstract:

Objective To investigate the clinical efficacy and safety of endoscopic selective varies devascularization (ESVD) combined with esophageal variceal sclerosis (EIS) in treatment of esophageal and gastric varices.Methods 260 patients with hepatic sclerosis complicated with esophageal and gastric varices rupture and bleeding were selected. According to different treatment methods, they were divided into three groups: esophageal variceal ligation treatment group (EVL group), esophageal variceal sclerotherapy treatment group (EIS group) and combined treatment group (ESVD combined EIS group). After two years follow-up, the improvement rate of varicose veins (after three months), the rate of early rebleeding (within two weeks), the rate of delayed rebleeding (within three months), the total rebleeding rate (within 2 years), the occurrence of complications and the treatment cost were compared.Results The improvement rate of varicose veins in the three groups was compared: the total improvement rate was 93.5% (243/260), and the combined treatment group was higher than that the other two groups (P < 0.05); Compared the early rebleeding rate of three groups, there was no significant difference among the three groups (P > 0.05), the delayed rebleeding rate and the total rebleeding rate in combined treatment group were lower than those in other two groups (P < 0.05); None of the three groups had ectopic embolism, incidence rate of postoperative fever in combined treatment group was significantly higher than that in other two groups (P < 0.05), the postoperative pain in the ligation treatment group was higher than that in other two groups (P < 0.05); The treatment cost in combined treatment group was significantly higher than that in the other two groups (P < 0.05).Conclusion ESVD combined with EIS therapy could be effective for esophageal-gastric varicose. The incidence of complications was not significantly increased, but the cost of treatment may be high.